The Relationship of Suicide Death to Baker Act Examination, Client Characteristics and Service Use Patterns

Publication Date: 6/1/2008

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Suicide is the eleventh leading cause of death across all ages in the United States. Florida had the third highest number of suicide deaths among all states in 2005 with over 2,300 deaths (CDC WISQARS, 2008; Kung, Hoyert, Xu, & Murphy, 2008). In Florida, it was the tenth leading cause of death in 2005, ranking as high as the second leading cause of death for 25-34 year olds in the state (CDC WISQARS, 2008).

Risk factors for death by suicide include being male, having a diagnosis of depression and/or a substance use disorder, and having made a previous suicide attempt (CDC WISQARS, 2008; Conwell et al., 1996). Protective factors which have been shown to decrease the likelihood of death by suicide include engagement in effective mental health and substance abuse treatment services, restricted access to lethal means, and cultural beliefs which discourage suicide (Appleby, 1992; SPRC, 2001). 

Florida's mental health statute regarding acute and involuntary care (The Baker Act), allows for involuntary examinations for up to 72 hours with evidence of mental illness and harm/neglect to self or others. Medicaid enrollment data analysis for the state of Florida indicate that almost half of the 125,000 Baker Act examinations which occur annually are for those who are Medicaid enrolled for at least a portion of the year in which their involuntary examination occurs and a disproportionately large number of these exams are accounted for by a relatively small group of people. Medicaid enrollees who have had a Baker Act examination in the past year are three times more likely to die by suicide than enrollees with no examination (Becker et al., 2005).

This study was aimed at providing a better understanding of the Medicaid funded services and the extent to which they were used by those who died by suicide, as well as an examination of service patterns and how they were related to this negative outcome. Lack of service use for those who were enrolled in Medicaid and died by suicide would suggest problems with diagnosis and/or access to key services. Use of certain services that are related to suicide may suggest the need to more carefully address (or assess for) suicide for individuals accessing such services and/or address issues with the services themselves. The goal of this study was to identify these issues in a way that will allow AHCA to use Medicaid funds in such a way that contributes to reductions in suicides.